Treatment of Sudden Cardiac Arrest

Treatment Of Sudden Cardiac Arrest (SCA)

For victims of sudden cardiac arrest (SCA), the time from collapse to defibrillation is the single greatest determinant of survival. That is why the Louis J. Acompora Memorial Foundation advocates the accessibility of automated external defibrillators (AED). The window of opportunity is short. Survival for cardiac arrest caused by ventricular fibrillation (VF) declines by approximately 7 to 10 percent for each minute without defibrillation. Beyond 12 minutes following a collapse, the cardiac arrest survival rates are only 2 to 5 percent.

Emergency medical services (EMS) systems that can be accessed quickly by telephoning 911 have been shown to improve survival form SCA by providing early defibrillation. However, most EMS systems cannot deliver defibrillation in a time frame that can significantly increase survival from SCA. As a result, the national survival rate for SCA hovers around a dismal 5%.

Learn the Chain of Survival

The actions taken during the first few minutes of an SCA emergency are critical to victim survival. These include:

The chain of survival concept is designed to quickly bring help to the victim’s side; That which can deliver the critical lifesaving interventions needed to survive. Cardiopulmonary resuscitation (CPR) brings oxygen into the body through rescue breathing and circulates oxygen-saturated blood through the performance of chest compressions. CPR helps keep the brain and other vital organs alive until the first responders, who might include police, firefighters, or trained rescuers in the school setting, can provide lifesaving defibrillation.

EMS or hospital personnel can then provide advanced care to help the victim who does not respond to defibrillation or to stabilize the heart rhythm following successful resuscitation to prevent subsequent cardiac arrest.

Early access requires prompt recognition of medical emergencies that need time-critical basic life support (BLS) interventions including heart attack, stroke, foreign-body airway obstruction, and respiratory and cardiac arrest. Early access (phoning 911 or activating the emergency response system) activates EMS providers quickly, who can respond with defibrillation and critical advanced care. However, defibrillation delivered by EMS personnel often results in low survival rates since the time from collapse to defibrillation is too long. In New York City and Chicago, survival rates of only 1 to 2% were recorded in systems that used EMS providers to deliver the first shock.

Early CPR is the best treatment for cardiac arrest until the arrival of an AED and advanced care. Early CPR prevents VF from deteriorating to asystole (flatline), may increase the chance of successful defibrillation, contributes to the preservation of heart and brain function, and significantly improves survival.

Early defibrillation is the single greatest determinant of survival for victims of cardiac arrest. Public Access Defibrillation (PAD), placing AEDs in the hands of trained laypersons, holds the potential to be the single greatest advancement in the treatment of VF arrest since the development of CPR. PAD programs using trained flight attendants and police officers have achieved extraordinary rates of resuscitation — as high as 49%. This nearly doubles the resuscitation rates previously achieved by the most successful EMS programs.

These BLS actions—early access, early CPR, and early defibrillation— serve as the foundation for emergency cardiac care throughout the community. Each community should identify their weaknesses and strengthen their chain of survival through CPR training programs, implementing effective PAD initiatives, and optimizing their EMS system.

The amazing truth is that teachers, students, and other lay rescuers at the scene of the emergency can safely provide three of the four links in the chain of survival. Lay rescuers can easily be trained in CPR and use of an AED in as little as 4 hours.